Within the study, the average number of hot flashes per week fell from about 80 to 8 and there was a marked decrease in nighttime awakenings, according to the Lancet.

Hot flashes and sleep dysfunction are not uncommon occurrences in breast cancer survivors, especially those who take anti-estrogen drugs.

The women involved in the research were given one nerve block during the course of the study, but they were allowed a second one if they thought the effects of the first block was starting to subside.

Of 13 women, 8 asked for a second block, said researchers. As mentioned above, the number of hot flashes per week decreased and “severe” hot flashes basically disappeared.

The women participating said night awakenings dropped from 19.5 per week before treatment to 1.4 per week after the nerve block.

And the heart problems surface at a much earlier age than in people who did not suffer cancer as children.

Childhood cancer survivors “have approximately a five to 10 times increased risk of having heart disease compared to their healthy siblings,” said study lead author Dr. Daniel A. Mulrooney, assistant professor of pediatrics at the Masonic Cancer Center of the University of Minnesota, Minneapolis.

Mulrooney was expected to present his findings Thursday night at the American Society of Clinical Oncology annual meeting, in Chicago.

There are an estimated 270,000 survivors of childhood cancer in the United States, and 11 million cancer survivors total.

While the cancer survivors in the new study ranged in age from 8 to 51, the average age of those with heart problems was only 27.5 years.

“We’re talking about a very young population that’s having very significant cardiac disease and is likely not being monitored appropriately,” Mulrooney added. “It is very important that they be followed and that risk factors and cardiovascular monitoring that we would think of in an older population be implemented in a younger population.”

The findings aren’t entirely surprising. Previous research, much of it with the same group of survivors, has shown an increased risk of cardiovascular disease in survivors of childhood and adolescent cancer.

The new analysis, the longest follow-up to date, provides updated information on 14,358 five-year survivors of childhood cancer. All the participants were diagnosed with one of eight cancers (including leukemia, lymphoma and brain malignancies) at 21 years of age or younger, between 1970 and 1986.

The study participants provided information on their own heart health, which was then compared to a control group of 3,899 healthy siblings.

Compared to the healthy brothers and sisters, the survivors of childhood cancer were almost six times more likely to report congestive heart failure; about five times more likely to report having had a heart attack or valvular heart disease; more than six times likelier to have pericardial disease (the pericardium is the sac that surrounds the heart); more than eight times as likely to have had an angiography; and 10 times more likely to have atherosclerosis, or hardening of the arteries.

Exposure to the chemotherapy drug anthracycline increased the risk of congestive heart failure about fourfold, roughly doubled the risk of pericardial and valvular disease, and almost tripled the odds of having had an angiography, the study found.

Radiation treatment to the heart doubled the risk of congestive heart failure, heart attack and pericardial disease, almost tripled the risk of valvular disease, and increased the risk of atherosclerosis by a factor of more than five, according to the study.

Dr. Karen Burns is clinical director of the ATP5+ Clinic for Childhood Cancer Survivors at Cincinnati Children’s Hospital. She said most of the heart problems seen in survivors of childhood cancer come from the class of chemotherapy drugs called anthrocyclines, which cause problems with cardiac muscle, and from radiation, if the radiation field included the heart.

Although monitoring for heart disease in childhood cancer survivors is already in place in many specialized facilities, Burns said she hoped that, “if this study is available to the general public, it will encourage people who are survivors to get closer follow-up.”

Mulrooney added: “We see this in our long-term follow-up clinic. We identify patients who are at risk based on this analysis and may do an echocardiogram or a lipid panel, things we might not typically do in a 20-year-old. There are tools out there, and getting this knowledge out there as well would be helpful so primary-care physicians will be more aware, oncologists and cardiologists will be aware, and patients as well.”

By extension, the same genetic signature may also identify patients with less aggressive forms of the cancer who would be able to forego chemotherapy.

“Using this signature, we can identify up to 30 to 40 percent of stage I patients who might benefit from post-surgery chemotherapy and maybe up to 30 to 40 percent who might not benefit,” said study author Dr. Ming Tsao, who will present the finding June 1 at the American Society of Clinical Oncology (ASCO) annual meeting, in Chicago. “The idea is that this could potentially supercede staging, although we definitely need more studies. [The information] is not immediately useful.”

Previous trials have shown a benefit for stage I and II non-small cell lung cancer patients who received chemo after surgery. But, so far, the benefit has been confined mostly to stage II patients.

Even so, the distinction is not clear-cut. Some 30 percent of stage I patients who don’t get added chemotherapy will die of a disease recurrence, and it’s also possible that some stage II patients might not need chemotherapy after surgery.

“The goal of this study was to identify the genetic characteristics that could potentially be used to predict more precisely the likelihood of clinical outcomes, so those who need post-surgery chemo should get it and those who do not need it do not get it,” explained Tsao, who is professor of laboratory medicine at the University of Toronto and a senior scientist at Princess Margaret Hospital in Toronto.

Gene expression profiling was performed on frozen tumor tissues from 64 patients as part of a follow-up analysis of a National Cancer Institute of Canada trial. Researchers then identified a group of 15 genes that divided the patients into high-risk (33 patients) and low-risk (31 patients) categories.

The signature was then validated in five other databases comprising a total of 372 stage I and II lung cancer patients.

Chemotherapy reduced the risk of death in high-risk patients (both stage IB and stage II) by about 67 percent, but not in low-risk patients.

While a previous analysis showed that overall, only patients with stage II disease benefited from chemotherapy after surgery, this study has demonstrated that the 15-gene signature may identify patients with both stage I and II cancers who would benefit from postoperative chemotherapy, further supporting its use in the selection of appropriate treatments.

In other news from the meeting, scientists from the University of Medicine and Pharmacy Iuliu Hatieganu in Romania have demonstrated for the first time that maintenance therapy (given after standard “induction” chemotherapy) with the chemotherapy drug Alimta (pemetrexed) extended time to recurrence by 50 percent.

“The data revealed a remarkably statistically significant 40 percent reduction in the risk of progression with pemetrexed, and a doubling of the median progression-free survival,” said study author Dr. Tudor Eliade Ciuleanu, an associate professor at the University of Medicine and Pharmacy Iuliu Hatieganu in Romania.

The study involved 663 patients with advanced non-small cell lung cancer who had already undergone the initial course of chemo. Eli Lilly, which makes the drug, was involved in the trial.

Patients who received Alimta lived for 4.3 months without a recurrence of the disease, versus 2.6 months for those taking a placebo. Overall survival was 13 months in the Alimta group as compared with 10.2 months in the placebo group.

Finally, a Duke Comprehensive Cancer Center study found that post-surgical lung cancer patients can do well with aerobic exercise regimens starting as little as one month after surgery.

Twenty individuals newly diagnosed with and who had undergone surgery for Stage I to Stage IIIb lung cancer were asked to exercise three times a week for one hour at a time on stationary bikes. After 14 weeks, participants reported being less tired and also had more aerobic fitness (as measured by oxygen levels after exercising).

Research from the Mayo Clinic in Rochester, Minn., shows that mastectomy rates for early-stage breast cancer dropped between 1997 and 2004, and then jumped between 2003 and 2006 — a time when MRI use also increased dramatically.

Researchers tracked 5,414 women who had surgery for early breast cancer between 1997 and 2006. They discovered that the mastectomy rate fell to 30 per cent in 2003 from 44 per cent in 1997.

However, by 2006, the mastectomy rate had risen to 44 per cent. In the same period, 2003-2006, the percentage of women who had MRI grew to 23 per cent in 2006 from 11 per cent in 2003.

Fifty-two per cent of women who had a pre-surgical MRI chose a mastectomy versus 41 per cent of women who did not have MRI.

The researchers believe an MRI, which is very effective at differentiating between benign and cancerous tumours, prompts women to undergo the more radical surgery. They’re not sure why.
Detection or uncertainty?

“What we don’t know from this study is whether the higher rate of mastectomy observed in our patients undergoing MRI is related to the detection of additional disease, or whether the uncertainty raised by MRI leads to greater anxiety for the patient and physician, thus leading patients and physicians to choose mastectomy over lumpectomy,” says Matthew Goetz, the study’s senior author, in a release.

The researchers stress that although MRIs and mastectomies seem related, the study cannot prove a cause and effect relationship. They suggest the individual choices of women with early-stage breast cancer be further explored.

Traditionally, breast-conserving surgery such as lumpectomy has been the standard of care for early-stage breast cancer.

The study’s results will be presented May 31 at the 44th Annual Meeting of the American Society of Clinical Oncology.

The drug, called RAD-001 or everolimus, may provide an option for patients with a difficult-to-treat cancer, the researchers said in an initial release of data ahead of a meeting of the American Society of Clinical Oncology.

The international team studied more than 400 people with kidney cancer, giving RAD-001 to 272 of them and placebos to 138 patients.

After six months, tumors had not grown or spread in 26 percent of patients who got RAD-001, compared to 2 percent of the placebo group.

On average, patients who got RAD-001 enjoyed four months of so-called progression-free survival compared to just under two months for those who got the placebo.

Independent monitors who watch drug trials were so impressed by the results that they stopped the trial last February so everyone could get RAD-001.

“This study has given us a new and clearly useful tool for treating renal cell tumors, and everolimus is an important step forward in terms of disease management and quality of life for patients living with this disease,” said Dr. Robert Motzer of Memorial Sloan-Kettering Cancer Center in New York, who led the study.

Full details will be presented on May 31 at the ASCO annual meeting. Novartis has said it intends to file for regulatory approval of the drug later this year.

Kidney cancer will be diagnosed in 54,390 people in the United States this year and will kill 13,010, the American Cancer Society projects.

The drug works by blocking a protein known as mTOR and disrupting the growth, division and metabolism of cancer cells.

The once-a-day pill is also being tested in other cancers including lymphoma and neuroendocrine tumors.

“For almost 20 years, we made no headway in the management of advanced kidney cancer,” Motzer said in a statement.

“Based on the results of this trial, everolimus could become another tool in our armamentarium and, in the future, kidney cancer is likely to be managed as a chronic disease with these types of treatment advances.”

(Reporting by Maggie Fox; Editing by Xavier Briand)